Introduction. The aim of the study was to introduce a new BKV PCR protocol in our centre and to verify its accuracy as well as to assess the prevalence, risk factors of BK virus replication, course of BKV infection and therapeutic approaches in simultaneous pancreas and kidney (SPK) recipients in order to design a screening protocol. Methods. The results analysed by both Affigene® and Transplantation Virology, Basel PCR protocols were compared. Thereafter 183 SPK patients were examined to assess the prevalence of BK viremia, viruria and BKVN and to identify the risk factors of BKV replication. The cases of retransplantation after a graft loss due to BKVN were retrospectively described. Results. 100 of results were analysed according to the Affigene ® and Transplantation Virology, Basel PCR protocols with the accordance of 95%, Rho = 0,946, 95% CI: 0.920 - 0.963, P<0,0001, Bland-Altman plot analyses: bias Basel PCR protocol/Affigene® BKV trender: -0,1 (mean) *±1.96 SD: -1,6 - 1,3] for both methods. Point-prevalence was assessed in 183 patients; Viruria found in 17,3 %, viremia in 3.8% of patients. High-level viruria >107 copies/mL detected in 3,7% of patiets, high-level virémia >104 in 1,6% of patients simultaneously with high-level viruria. BKVN was found in 0,5% of patients. Diabetes duration...

The need to have mechanisms and Technologies for the control of blood glucose levels is essential for people who have diabetes of any type. This disease still has no cure and is one of the main risk factors for cardiovascular diseases, such as heart attack, stroke, renal complications etc. The number of diabetic people in the world and in Brazil is alarming, in addition, Brazilians occupy the fourth place in the world ranking according to the last survey of the year, 2015, made by the International Diabetes Federation (IDF). Several studies has been conducted in order to obtain the best glycemic control of people with diabetes, one of the current forms of control under investigation is the development of an artificial pancreas. Through the union of three systems: glucose monitoring system, control algorithm and actuator system through an insulin infusion pump, it is possible to obtain efficient results in glycemic control as they already have studies. This work consists of developing a prototype of a low-cost and low-power embedded control system, Hardware in Loop (HIL), based on Arduino nano microcontroller, which can control the blood glucose level of a model of a type 1 diabetes patient, considering some perturbations and noises, using the Kalman filter as estimator. The results obtained with the implementation of the controller are analyzed in order to obtain a better performance. / A necessidade de ter mecanismos e tecnologias para o controle dos níveis de glicose no sangue é essencial para pessoas que possuem diabetes de qualquer tipo, visto que esta é uma doença que ainda não possui cura e é um dos principais fatores de riscos para doenças cardiovasculares, como infarto, AVC, complicações renais e etc. O número de pessoas diabéticas no mundo e no Brasil é alarmante, além disso, tem-se que os brasileiros ocupam o quarto lugar no ranking mundial de acordo com o último levantamento no ano de 2015 feito pela International Diabetes Federation (IDF). Vários estudos têm sido realizados no intuito de obter o melhor controle da glicemia de pessoas com diabetes, uma das formas de controle que está sendo pesquisada atualmente é o desenvolvimento de um pâncreas artificial. Através da união de três sistemas, sendo estes: o de monitoramento da glicemia, o de algoritmo de controle e o de atuador através de bomba de infusão de insulina, é possível que sejam obtidos resultados eficientes no controle da glicemia como já têm mostrado alguns estudos. Este trabalho consiste em desenvolver um protótipo de um sistema de controle embarcado, Hardware in Loop (HIL), baseado no microcontrolador nano Arduino, de baixo custo e de baixo consumo de energia que possa controlar o nível de glicose no sangue de um modelo de um paciente com diabetes tipo 1, considerando algumas perturbações e ruídos, utilizando o filtro de Kalman como estimador. Os resultados obtidos com a implementação do controlador são analisados buscando a obtenção de um melhor desempenho. / São Cristóvão, SE

Orientador: Carla Beatriz Collares Buzato / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-13T09:31:49Z (GMT). No. of bitstreams: 1 Carvalho_CarolinaPradodeFranca_D.pdf: 11012408 bytes, checksum: 13da099b8bd43a93f7783c961a08d48f (MD5) Previous issue date: 2009 / Resumo: O objetivo central dessa tese foi estudar o papel das junções comunicantes (GJs) no processo de maturação da célula B e na patogênese da diabetes tipo 2. Para isso, foram utilizados dois modelos animais. No modelo in vivo de maturação da célula B e do processo secretório de insulina foram empregados ratos em vários estágios do desenvolvimento (fetal, neonatal, jovem e adulto). No modelo de diabetes tipo 2 foram utilizados camundongos C57BL/6, wild-type e knockout para o gene do receptor de LDL (LDLR -/-), alimentados com dieta hiperlipídica. No primeiro modelo de estudo, observamos, por técnicas morfológicas (imunocitoquímica) e de biologia molecular (Western Blot, RT-PCR semi-quantitativo e qPCR) que a expressão gênica e protéica de Cx36 e Cx43, se altera durante o desenvolvimento. Os dados de microinjeção intracelular de traçadores confirmam tais resultados que sugerem que ilhotas de ratos recém-nascidos apresentam menor número de canais intercelulares associados à membrana e, conseqüentemente, um menor acoplamento intercelular mediado pelas junções comunicantes em comparação às ilhotas de adultos. Esses resultados estão de acordo com a observação de que a célula B durante o período perinatal mostra uma menor resposta secretória à glicose e sugerem a participação da comunicação intercelular mediada pelas junções comunicantes no processo de maturação da célula B. No caso do modelo in vivo de diabetes tipo 2, o estudo iniciou com a caracterização do quadro metabólico e de aspectos da morfologia e morfometria do pâncreas endócrino de animais submetidos ao tratamento com a dieta hiperlipídica. Os dados obtidos demonstram que os animais submetidos a essa dieta por um curto período de tempo já apresentam alterações metabólicas típicas da fase inicial da diabetes (hiperglicemia moderada, hiperinsulinemia, intolerância á glicose e resistência à insulina), bem como modificações de parâmetros da morfometria do pâncreas endócrino. Posteriormente, foi analisada a expressão e localização celular das proteínas juncionais (Cx36, Cx43 e ZO-1) e o aspecto funcional dos canais formados pela GJ, através da microinjeção de marcadores intracelulares. Observamos que os animais tratados com dieta hiperlipídica apresentam tendência de diminuição de expressão de Cx36 acompanhada por alteração no padrão de marcação para essa proteína. Esses dados estão de acordo os de microinjeção que revelam uma pequena diminuição do grau de acoplamento celular após o tratamento com a dieta hiperlipídica. As alterações observadas para Cx36 foram acompanhadas por modificações no grau de expressão e de localização celular de ZO-1, proteína envolvida em processos como a organização dos canais intercelulares da GJ na membrana e no turnover de vários subtipos de conexina. Esses resultados indicam que a comunicação intercelular, particularmente a mediada por canais formados pela Cx36 parecem desempenhar importante papel na patogênese da diabetes tipo 2, desde sua fase inicial. / Abstract: Intercellular communication and adhesion among pancreatic B-cells are crucial for a proper insulin biosynthesis and secretion. The aim of this work was to investigate the role of gap junction (GJ) mediated-intercellular communication in the processes of maturation and dysfunction of B-cells. It is well known that fetal and neonatal rat pancreatic B-cells exhibit a reduced insulin secretory response to glucose and to other secretagogues as compared to adult ones. Based on this finding, we have used Wistar rats at different stages of development (fetal, neonatal, young and adult) as a model of B-cell maturation. As a model of type 2 diabetes, C57BL/6 mice (wild-type) and LDL receptor-deficient mice were fed a high fat diet up to 60 days. The cellular expression of GJ connexin (Cx) subtypes found in the endocrine pancreas (Cx36, Cx43 and Cx45) was assessed by immunohistochemistry, Western Blot, quantitative and semi-quantitative RTPCR. Our results indicate that young and adult endocrine pancreas express relatively high levels of Cx36 on B-cells in comparison with the other groups. Meanwhile, fetal and neonatal islets express predominantly Cx43 on non B-cells located at the islet periphery. Islet microinjection of GJ tracers revealed that neonatal B-cells display lower intercellular exchange of the cationic molecule Ethidium Bromide (EB) in comparison with the adult ones, which is in accordance with their differences in Cx36 expression. No significant differences were found in expression and localization of Cx45 among all animal groups. Regarding the animal type 2 diabetic model, a metabolic characterization showed that the high-fat diet for 60 days induces glucose intolerance, insulin resistance, hyperinsulinemia and moderate hyperglycemia in both mice groups (LDLr knockout and wild-type groups). High-fat fed mice showed a subtle decrease in Cx36 islet expression and in the B-cell intercellular exchange of EB in comparison with the chow-fed group (control). We also observed an alteration in the pattern of Cx36 labeling in immunohistochemistry assays. The high-fat diet induced a redistribution of Cx36 within the islets from a disorganized pattern (more commonly seen in control mice) to a sub domain-pattern where Cx36 plaques demarcate groups of B-cells. These changes in Cx36 islet distribution observed in high-fat fed mice were accompanied by a similar pattern of immunolabeling for ZO-1, but an increase in its islet expression, a tight junctional protein that seem to be involved in Cx turnover and membrane organization of Cx-made channels. Taken all together, these findings suggest that cell-cell coupling mediated by GJ may play an important role in the pancreatic B-cell maturation observed during endocrine pancreas development as well as in the early stages of type 2 diabetes pathogenesis. / Doutorado / Histologia / Mestre em Biologia Celular e Estrutural

Introdução: O pâncreas é um órgão suscetível a lesões de isquemia-reperfusão (I/R). Estratégias terapêuticas para reduzir os danos produzidos pela I/R podem melhorar os resultados nos transplantes de pâncreas-rim. Apesar dos efeitos hemorreológicos da pentoxifilina, esta droga tem ação anti-inflamatória através da inibição da ativação de NF-kB e da produção de TNF-alfa. Foi demonstrado previamente que a pentoxifilina diminui a resposta inflamatória em modelos experimentais de pancreatite aguda e I/R hepática. Assim, a pentoxifilina pode contribuir na redução da lesão pancreática e da reposta inflamatória sistêmica em um modelo de I/R pancreática. Objetivo: Avaliar o efeito da administração de pentoxifilina em um modelo experimental de I/R pancreática em ratos. Métodos: A I/R pancreática foi realizada em sessenta ratos Wistar, por um período de uma hora através da oclusão da artéria esplênica. Os animais deste experimento foram divididos em três grupos: Grupo 1 (sham; realizado procedimento cirúrgico sem indução da I/R), grupo 2 (controle; realizado indução da I/R) que recebeu solução salina por via endovenosa e grupo 3 (pentoxifilina; realizado indução da I/R associado ao tratamento) que recebeu pentoxifilina (25mg/kg) por via endovenosa. Foram colhidas amostras de sangue para dosagem de amilase, creatinina, ureia, fator de necrose tumoral ? (TNF-alfa), interleucina-6 (IL-6) e interleucina-10 (IL-10). Os níveis de malondialdeído (MDA) pancreático, da mieloperoxidase (MPO) pulmonar e a histologia pancreática também foram avaliados. Resultados: A inibição do TNF-alfa pela pentoxifilina apresentou efeitos benéficos neste modelo experimental. O grupo de animais tratados com pentoxifilina apresentou níveis séricos significantemente menores de TNF-alfa, IL-6 e IL-10 em comparação ao grupo controle (p < 0,05). Não foram observadas diferenças significantes entre estes grupos em relação aos níveis de amilase, creatinina, ureia, MDA pancreático e MPO pulmonar. Entretanto, no grupo de animais tratados com pentoxifilina, o dano histológico pancreático foi menor em comparação ao grupo controle (p < 0,05). Conclusão: A administração de pentoxifilina reduziu a resposta inflamatória sistêmica e a lesão histológica pancreática / Introduction: The pancreas is an organ extremely susceptible to periods of ischemia. Therapeutic strategies to reduce the occurrence of pancreatic ischemiareperfusion (I/R) injury might improve outcomes in human pancreas and kidney transplantation. In addition to its haemorrheologic effects, pentoxifylline has an antiinflammatory effect by inhibiting NF-?B activation and TNF-alfa production. It has been previously demonstrated that pentoxifylline induces an anti-inflammatory response in acute pancreatitis and liver I/R models. This led to the hypothesis that pentoxifylline might reduce pancreatic lesion and the systemic inflammatory response in pancreatic I/R injury. Objective: The aim of this experimental study was to evaluate the effect of pentoxifylline administration in a rat model of pancreatic I/R injury. Methods: Pancreatic I/R was performed in sixty Wistar rats over one hour by clamping the splenic vessels. The animals of this study were divided into three groups: group 1 (sham, surgical procedure without pancreatic I/R induction), group 2 (control, I/R induction) received saline solution administered intravenously, and group 3 (pentoxifylline, I/R induction plus treatment) rats received pentoxifylline (25 mg/kg) administered intravenously. Blood samples were collected to enable the determination of amylase, creatinine, urea, tumour necrosis factor-? (TNF-alfa), interleukin-6 (IL-6) and interleukin-10 (IL-10). Pancreatic malondialdehyde (MDA) content, pulmonary myeloperoxidase (MPO) and pancreas histology were also assessed. Results: Inhibition of TNF-alfa by pentoxifylline shows beneficial effects in this experimental model. Significant reductions in serum TNF-?, IL-6 and IL-10 were observed in pentoxifylline group compared with control group (p < 0.05). No significant differences in serum amylase, creatinine, urea, pancreatic MDA or pulmonary MPO were observed between these two groups. However, the pancreatic histological damage was significantly lower in pentoxifylline treated group compared with control group (p < 0,05). Conclusion: Pentoxifylline administration reduced the systemic inflammatory response and the pancreatic histological lesion

Orientadores: Henrique Marques Barbosa de Souza, Carla Beatriz Collares Buzato / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Biologia / Made available in DSpace on 2018-08-25T12:54:45Z (GMT). No. of bitstreams: 1 Hernandes_LeticiaHelenaPinto_M.pdf: 22200442 bytes, checksum: 95e81ba6b7934db5b7e01d5eea75202c (MD5) Previous issue date: 2014 / Resumo: O Diabetes Mellitus tipo 2 (T2DM) representa uma das principais doenças do mundo moderno, e é caracterizado pelo comprometimento da homeostase glicêmica do organismo, resultante de uma combinação da redução da sensibilidade periférica à insulina e o comprometimento da função das células-'beta'. Estudos recentes sugerem que Coup-TFII possui um papel importante na homeostase glicêmica e no metabolismo energético. Apesar destes trabalhos representarem fortes indícios, ainda é desconhecido se Coup-TFII desempenharia este papel modulador da homeostase glicêmica e do metabolismo energético em indivíduos com T2DM. O objetivo deste trabalho foi investigar o padrão de expressão de Coup-TFII em camundongos apresentando um quadro pré-diabético. Para isto, foram utilizados camundongos C57BL/6 tipo selvagem tratados com dieta hiperlipídica (dHL) por 60 dias (animais dHL). A caracterização metabólica revelou que estes animais apresentaram características de quadro pré-diabético, i.e., sobrepeso, resistência periférica à insulina associada à moderada hiperglicemia, significativa hiperinsulinemia (resultante da hiperplasia compensatória de células-'beta') e distúrbios na secreção de insulina, tanto no estado basal (2,8 mM de glicose), quanto em condição estimulatória (16,8 mM de glicose). A análise da expressão de Coup-TFII por qPCR revelou uma redução dos níveis transcricionais deste gene em ilhotas dos animais dHL. Estes resultados indicam que a relação negativa previamente demonstrada entre hiperglicemia, hiperinsulinemia e reduzida secreção de insulina e a expressão de Coup-TFII também ocorre no quadro pré-diabético desenvolvido pelos animais dHL. Interessantemente, análise do conteúdo proteico de Coup-TFII revelou um aumento significativo de 33,6% nos animais dHL, resultado que contrasta com a redução da transcrição deste gene nas células-'beta' destes animais. Uma possível explicação seria pelo papel fundamental que Coup-TFII exerce no processo de proliferação das células-'beta' dependente da via Wnt/'beta'-catenina, observada durante o desenvolvimento e potencialmente atuando na hiperplasia compensatória nos animais dHL. Além disso, trabalhos recentes demonstraram que Coup-TFII atua como um regulador negativo de sua própria transcrição em células-'beta'. Portanto, com 60 dias de tratamento o quadro de hiperplasia nos animais dHL demandaria maiores níveis da proteína de Coup-TFII em comparação com os animais Ctr. Uma vez elevado, este nível proteico de Coup-TFII, juntamente com os efeitos das alterações metabólicas, teriam um efeito negativo sobre a transcrição de Coup-TFII nos animais dHL / Abstract: Type 2 diabetes mellitus (T2DM) is one of the most important diseases in the modern world, and is characterized by the compromise of the glycemic homeostasis and a result of a combination of insulin resistance and impaired 'beta'-cell function. Recent studies show that nuclear receptor COUP- TFII (Chicken ovalbumim upstream promoter transcription factor II) plays an important role in regulating glycemic homeostasis and energy metabolism. Although these results are a strong hint, it is still unknown whether Coup-TFII would have a role modulating glycemic homeostasis and energy metabolism in individuals suffering from T2DM. The aim of this work was to investigate the expression pattern of the transcription factor Coup-TFII in mice displaying pre-diabetic condition. To this aim, C57BL/6, wildtype mice were treated with high fat diet (dHL, from the Portuguese dieta hiper lipídida) for 60 days (dHL mice). Metabolic characterization confirmed that dHL mice display characteristics of pre-diabetic condition, i.e., overweigh, insulin resistance associated with moderate hyperglycemia, hyperinsulinemia (as a result of hyperplasia of 'beta'-cells) and impaired insulin secretion both, in basal and high blood glucose concentrations. Gene expression analysis for Coup-TFII by qPCR revealed a significant reduction of its transcripts in pancreatic islet of dHL animals. These results indicate that the previously described negative relationship between hyperglycemia, hyperinsulinemia and imparted insulin secretion and Coup-TFII expression is also happening in the pre-diabetic condition developed by dHL animals. Interestingly, analysis of the protein expression of Coup-TFII reveled a significant increase of 33,6% in dHL animals, a result that the contrasts with the reduction of Coup-TFII transcripts observed in these animals. One possible explanation is the essential role that Coup-TFII plays in the Wnt/'beta'-catenin-dependent 'beta'-cell proliferation, in addition to the negative feedback loop observed in 'beta'-cells for Coup-TFII on its own expression. By 60 days of treatment, 'beta'-cell proliferation during hyperplasia in dHL animals would require levels of Coup-TFII protein higher then in control animals. Once increased, this higher protein level, in addition to the metabolic alterations, would have a negative effect on Coup-TFII transcription in dHL animals / Mestrado / Biologia Celular / Mestre em Biologia Celular e Estrutural

Conselho Nacional de Desenvolvimento Científico e Tecnológico / Essential oils of natural origin and low cost have antimicrobial properties and can increase broilers performance, constituting an alternative to growth promoters based on antibiotics for poultry production; however, they can produce toxic effects. Serum biochemical parameters regarding to pancreatic, renal and hepatic functions of broiler chickens fed diets supplemented with antibiotics or essential oils of oregano, sage, rosemary and pepper aqueous crude extract (OLES) were evaluated. Animals (n=910) were distributed within five treatment groups with seven replicates of 26 birds each. Control group received a diet without additives; treatment Tatb received an antibiotic growth promoter diet; treatments T50, T100 and T150 received feed supplemented with 50, 100 and 150 ppm of OLES, respectively. At 42 days, 11 animals per group were slaughtered and blood samples were collected for serum biochemical profile analysis (lipase, amylase, urea, uric acid, aspartate aminotransferase - AST, gama glutamyltransferase, total cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides, total protein, albumin, globulins and albumin:globulins ratio). The results showed elevated serum lipase, uric acid, urea and AST, suggesting the impairment of kidney and liver functions caused by OLES. More studies are needed for essential oils dose adjustment in the diet, providing benefits without being harmful to the animal. / Devido às exigências atuais do mercado externo por alimentos de qualidade, custo acessível e de origem natural, os extratos de plantas com atividade antimicrobiana, como os óleos essenciais, são uma alternativa aos promotores de crescimento à base de antibióticos na produção de frangos, podendo aumentar o desempenho dos animais. Essas substâncias possuem rápida metabolização hepática, curta meia vida e eliminação renal e podem produzir efeitos tóxicos em altas doses ou estimular a secreção pancreática. Nesse contexto, avaliaram-se as funções pancreática, renal e hepática de frangos de corte alimentados com ração isonutritiva, antibióticos ou óleos essenciais de orégano, sálvia, alecrim e extrato aquoso de pimenta (OLES) em diferentes concentrações na ração. Novecentos e dez frangos foram alocados em cinco grupos de tratamento, com sete repetições de 26 aves por tratamento. O grupo controle recebeu ração sem aditivos; o tratamento Tatb recebeu ração suplementada com promotor de crescimento à base de antibióticos; os tratamentos T50, T100 e T150 receberam ração suplementada com OLES nas concentrações de 50, 100 e 150 ppm, respectivamente. Aos 42 dias de idade, 11 aves por grupo foram abatidas e amostras de sangue foram colhidas para realização das mensurações séricas de lipase, amilase, uréia, ácido úrico, aspartato aminotransferase (AST), gama glutamiltransferase, colesterol total, lipoproteína de alta densidade, lipoproteína de baixa densidade, triglicerídeos, proteínas totais, albumina, globulinas e relação albumina:globulinas. Os resultados obtidos demonstraram elevação sérica significativa de lipase, ácido úrico, uréia e AST, sugerindo o comprometimento renal e hepático pelos OLES. Mais estudos são necessários para adequar as doses dos óleos essenciais na ração, que propiciem benefícios sem provocar danos ao animal.

Le diabète est une maladie qui touche 347 millions de personnes dans le monde (90% ayant un diabète de type 2) (OMS, septembre 2012). Elle se définit par une perturbation de la régulation de l’homéostasie glucidique avec un déficit dans la fonction des cellules ß du pancréas. Dans le diabète de type 1, ce déficit est provoqué par une destruction autoimmune. Dans le diabète de type 2, il est dû à une insulino-résistance périphérique conduisant à un épuisement des cellules ß qui ne peuvent plus maintenir leur fonction. Une stratégie pour restaurer une masse fonctionnelle de cellules ß est, soit d’induire la prolifération de ces cellules in vitro avant de les greffer, soit d’induire leur prolifération in vivo. Cependant, ceci implique une meilleure compréhension des mécanismes moléculaires impliqués dans le cycle cellulaire des cellules ß pancréatiques humaines. L’objectif de ma thèse a été de disséquer ces mécanismes. Pour cela, nous disposons au laboratoire d’un outil unique, deux lignées de cellules ß pancréatiques humaines. Dans l’une d’elle, les transgènes immortalisant peuvent être délétés. Les cellules arrêtent alors de proliférer donnant des cellules ß pseudo-primaires. En comparant l’expression des régulateurs du cycle cellulaire de la lignée de cellules ß humaine immortalisées aux cellules ß humaine pseudo-primaires, nous avons pu montrer que le cycle de ces cellules était bloqué en phase G1. L’absence de plusieurs protéines responsables de la progression du cycle cellulaire en aval de cette phase a été confirmée dans les îlots humains. Nous avons également observé une diminution du temps de doublement des cellules ß humaines suite à leur traitement avec de la GH et de l’EPO. Suite à ce traitement nous observons également une activation du facteur de transcription STAT5 connue pour son implication dans la prolifération cellulaire des cellules ß de rongeurs. Enfin nous avons étudié l’effet que provoquait un apport nutritif sur la fonction et la prolifération des cellules ß humaines. Nous avons ainsi pu voir que les cellules répondaient mieux à la fonction ß avec un temps de doublement du nombre de cellules plus court dans un milieu enrichi en nutriment. De plus, dans ces conditions, l’autophagie, préexistante avant l’apport de nutriments et vraisemblablement due à un manque en énergie cellulaire, disparait. Ces résultats nous permettent de mieux comprendre les mécanismes contrôlant la prolifération des cellules ß pancréatiques humaines et d’envisager de nouvelles thérapies du diabète. / Diabetes is a disease that affects 347 million people worldwide (90% with type 2 diabetes) (WHO, September 2012). It is defined by a disturbance in the regulation of glucose homeostasis with a deficit in function of pancreatic beta cells. In type 1 diabetes, this deficit is caused by autoimmune destruction. In type 2 diabetes, it is due to peripheral insulin resistance leading to a depletion of beta cells that can no longer maintain their function. A strategy to restore a functional beta cell mass is, or of inducing proliferation of these cells in vitro prior to transplant, or to induce proliferation in vivo. However, this implies a better understanding of the molecular mechanisms involved in the cell cycle of human pancreatic beta cells. The aim of my thesis was to dissect these mechanisms. For this, we have a unique laboratory tool, two lines of human pancreatic beta cells. In one of them, immortalizing transgenes may be deleted. Then, the cells stop to proliferate giving pseudo- primary beta-cells. By comparing the expression of cell cycle regulators of the lineage of human beta cells immortalized pseudo- primary human beta- cells, we could show that the cycle of these cells was blocked in the G1 phase. The lack of several proteins responsible for cell cycle progression downstream of this phase has been confirmed in human islets. We also observed a decrease in the doubling time of human beta cells following treatment with GH and EPO. Following this treatment we also observe an activation of the transcription factor STAT5 known for its involvement in cell proliferation of rodent beta cells. Finally, we studied the effect that caused a nutrient supply on the function and proliferation of human beta cells. We have seen that the cells responded better to beta function with a doubling time shorter amount of cells in a nutrient enriched environment. In addition, under these conditions, autophagy, existing before the supply of nutrients and likely due to a lack of cellular energy, disappears. These results allow us to better understand the mechanisms controlling proliferation of human pancreatic ß and consider new diabetes therapies cells.

L’ADKP est la 5e cause de décès par cancer dans le monde occidental, et il est estimé qu’il constituera la 2e cause de mort par cancer d’ici à 2030. Le taux de survie à 5 ans est inférieur à 4%, et la médiane de survie est d’environ 6 mois. Ce pronostic sombre est dû à une pathologie asymptomatique dans les phases précoces du développement tumoral, résultant en un diagnostic tardif. Les tumeurs primaires sont constituées de structures épithéliales néoplasiques entourées par un stroma abondant empêchant l’accès des chimiothérapies aux cellules tumorales. La compréhension des mécanismes d’initiation et de progression tumorale est donc primordiale pour développer de nouvelles stratégies visant à la détection et à la prise en charge thérapeutique optimale des patients atteints d’ADKP. Le TGFbeta est une cytokine assurant de nombreuses fonctions physiologiques comme la régulation de l’immunité, la cicatrisation, le développement ou encore l’angiogenèse. Les résultats présentés dans ce manuscrit mettent en évidence que l’activation de la voie de signalisation TGFbeta perturbe la différenciation des cellules acineuses au cours du développement, et perturbe l’identité acineuse lorsqu’elle est activée dans le pancréas chez l’adulte. L’induction en parallèle de l’apoptose des cellules acineuses et d’une métaplasie acino-canalaire (ou ADM) mène à la disparition quasi-totale du tissu acineux au profit de structures canalaires typiques d’un pancréas en régénération. Lorsque l’oncogène KRASG12D est exprimé en parallèle dans le tissu pancréatique chez l’adulte, ce tissu canalaire régénératif est mis à profit par KRAS pour le développement précoce de lésions pré-néoplasiques. Mes travaux au sein de l’équipe du Dr. Laurent BARTHOLIN permettent donc de démontrer in vivo un nouveau rôle du TGFbeta dans la carcinogénèse pancréatique / PDA is the 5th cause of cancer related death in the western countries, and is estimated to move the second rank by 2020. The 5-year survival rate is less than 4%, and the median survival is around 6 months. The poor prognostic of this tumor is due to asymptomatic early phases of the disease, resulting in a late diagnosis. Primary tumors are composed by ductal neoplastic lesions embedded into a highly abundant stroma that prevents the access of chemotherapeutic drugs to the tumor cells. Thus, understanding tumor initiation and progression mechanisms is needed to develop new strategies aiming at detecting and taking care of patients in the most optimal manner. TGFbeta is a cytokine playing several physiological functions such as immunity regulation, wound healing, development or angiogenesis. Results presented in this manuscript demonstrate that activation of TGFbeta signaling disturb acinar cell differentiation during development, and disrupts acinar cell identity when activated in the adult pancreas. The simultaneous induction of acinar cell apoptosis and ADM leads to the massive loss of acinar cells and the emergence of ductal structures typical of pancreas regeneration. When the KRASG12D oncogene is expressed in combination with the activation of TGFbeta signaling, these regenerative duct structures are harnessed by KRASG12D to develop early neoplastic lesions. Thus, my work in Dr. Laurent BARTHOLIN’s team demonstrates a new function of TGFbeta in pancreatic carcinogenesis in vivo

L'objectif principal de cette thèse est d'étudier la valeur pronostique de la qualité de vie (QdV) en cancérologie etd'explorer son utilité tant pour la pratique clinique que pour la planification des essais.Pour ce faire, nous évaluerons la significativité statistique et clinique de rapport d'un modèle de prédiction composé defacteurs cliniques et de la Qdv par rapport à un modèle de prédiction composé uniquement de facteurs cliniques.La validation statistique et clinique de cette plus-value de la Qdv en oncologie, permettrait de construire des index plusprécis en termes de pronostic vital, et mieux adapter les traitements. En fonction de sa valeur pronostic, la Qdv pourraitservir de critère de stratification dans les essais randomisés en oncologie.Pour les différentes localisations et le stade concernés, la recherche des facteurs pronostics sera réalisée selon lesrecommandations publiées dans la littérature. La procédure suivante sera utilisée :> Sélection des facteurs pronostics par un modèle univarié.> Construction d'un modèle multivarié par sélection « forward », « backward » ou « stepwise » en respectant aumieux la « règle de 10 événements par variable ».> Si existence de scores pronostics étudier l'apport de la Qdv à ces scores.> Vérifications à posteriori des hypothèses du modèle.> Mesure de la concordance entre les valeurs prédites et les valeurs observées à l'aided'indicateurs comme le C-index d'Harell, la statistique de Schemper, le NR1 (Net Reclassification Improvement) et l'IDI (Integrated Discrimation Improvement) de d'Agostino. Analyse de sensibilité par rapport aux données manquantes dans les différentes dimensions de la qualité de vie.Validation interne et/ou externe du modèle. Recherche de valeurs seuil pour les différents scores de qualité de vie dans le but d'une meilleure applicationclinique.Trois localisations seront étudiées : Carcinome hépatocellulaire en situation palliative. Cancer du pancréas métastatique. Cancer colorectal métastatique / The primary objective of this thesis is to evaluate the added prognostic value of health-related quality of life (QoL) inoncology and to explore ils utility for routine clinical practice as well as for design of clinical trials.In a methodological point of view, we will fïrst compare statistical and clinical performances of a model based onclinico-biological variables and a model based on clinico-biological variables and QoL scores.After validation of ils prognostic value, optimal cut-off points for QoL scores will be explored and revised prognosticclassifications including QoL measures will be built. QoL could then be used to guide treatment assignment and asinclusion/exclusion criteria or as stratification criteria in randomized clinical trials.For the different types of cancer, the validation of the prognostic value of QoL for advanced cancer patients will beperformed according to standard recommendations. The following steps will be performed:> Selection of prognostic factors based on univariable Cox models.> Multivariable Cox models using stepwise procedure. The number of variables entering the multivariable modelwill be selected in such a way that the thumb rule (10 events per variable) will be respected.> If a prognostic System exists, compare its performance alone with ils performance after addition of QoL factorsas well as other clinico-biological factors not included in the prognostic System.> Verify model hypotheses.> Assess model performance using HarreH"s C-index, Schempers V statistic, The NRI (Net ReclassificationImprovement) and the IDI (Integrated Discrimination Improvement). Perform sensitivity analysis after imputation of missing QoL data. Internai validation ofnew models. Find cut-off values for QoL scales to facilitate their use in daily practice.Three type of cancer will be studied: Advanced hepatocellular carcinoma. Metastatic pancreatic adenocarcinoma. Metastatic colorectal cancer.

The dynamics of β-cell mass are at the focus of an extensive international effort to develop β-cell replacement therapies for type 1 diabetes. During normal fetal development endocrine cells emerge from a pool of PDX1+/SOX9+ multipotent progenitors that transiently express the proendocrine gene NGN3. These cells become hormone-positive and are seen to bud from the ductal structures and aggregate into islet clusters. Congenital hyperinsulinism in its diffuse form (CHI-D) is characterised by an increase in hormone-positive cells associated with ducts and diffuse patterns of insulin expression. CHI-D arises from mutations inactivating the KATP channel and is diagnosed following persistent episodes of hypoglycaemia caused by an inappropriate secretion of insulin. Whilst existing knowledge has focused on the β-cell, we have explored the histology of CHI-D across multiple pancreatic cell lineages. The starting hypothesis considered CHI-D as an over-exuberance of endocrine differentiation with a progenitor population underlying this process. We suggest CHI-D is not simply an excessive proliferation of pre-existing β-cells. Expression of many transcription factors involved in endocrine differentiation were unchanged in CHI-D, NKX2.2 was increased and persisted in δ-cells. The incidence of nucleomegaly was also confirmed in CHI-D samples, predominantly in the β- and δ-cell lineages. Whilst increases in endocrine cell proliferation were subtle, the ductal and acinar cell lineages had significantly elevated proliferation correlating with changes in cell cycle regulation. The expression of NGN3 was profiled in a range of human fetal samples to determine whether a competence window for endocrine differentiation exists during development. Peak expression was observed between 10-17 wpc whilst protein and transcript expression were both reduced by birth and postnatally. Combined with the data in CHI-D and postnatal controls, it is likely that endocrine commitment ceases in human towards the end of gestation and that further increases in β-cell mass rely on proliferation or NGN3-independent pathways. These data provide new clues for the pathological mechanisms of CHI-D and the establishment and maintenance of the β-cell mass in the human pancreas. We have shown an altered potential for cell proliferation in CHI-D in previously unappreciated ways and provide a rationale for studying molecular components of the β-cell to help unlock β-cell proliferation as a therapeutic option in diabetes.